CSI和BIS在儿童静脉麻醉中应用的比较  

Clinical Observation on the Application of Anesthesia Depth Monitoring in Children′s Radiofrequency Ablation.

作　　者：李立晶[1] 胡璟[1] 张建敏[1] 李多依[1] 孙岚 刘超[1] Li Lijing;Hu Jing;Zhang Jianmin(Department of Anesthesiology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院麻醉科,100045

出　　处：《医学研究杂志》2021年第4期114-118,共5页Journal of Medical Research

摘　　要：目的比较麻醉意识深度指数(cerebral state index,CSI)与脑电双频指数(bispectral index,BIS)在监测儿童静脉麻醉深度中的相关性和一致性,评价CSI用于儿科监测的可行性。方法择期全身麻醉下行心律失常射频消融手术的患儿60例,按年龄分为学龄前组(A组,3~6岁)25例和学龄组(B组,7~15岁)35例,ASA I~Ⅱ级,两组均给予丙泊酚2.5mg/kg、顺式阿曲库铵0.1mg/kg、芬太尼1μg/kg全身麻醉诱导后气管插管;麻醉维持期设定BIS目标值为65,采取闭环模式自动调整丙泊酚泵注给药速度,瑞芬太尼0.25~0.33μg/(kg·min)持续泵注。记录两组患儿入室时(T 1)、诱导完成时(T 2)、手术开始时(T 3)、手术30min(T 4)、60min(T 5)、90min(T 6)、停药时(T 7)、拔除气管导管时(T 8)、出室前(T 9)的CSI、BIS,并记录苏醒期T 7~T 9时的改良清醒镇静评分MOAA/S(Modified Observers Assessment of Alertness/Sedation scale)值。结果A组T 1~T 2诱导期、T 3~T 6维持期、T 7~T 9苏醒期CSI与BIS的Spearman相关系数分别为0.88、0.79和0.78(P<0.05);T 1~T 6时CSI低于BIS(P<0.05),T 8~T 9时CSI高于BIS(P<0.05);T 7~T 9的CSI与MOAA/S的Spearman相关系数为0.87(P<0.05),BIS与MOAA/S的Spearman相关系数为0.82(P<0.05)。B组诱导期、维持期、苏醒期CSI与BIS的Spearman相关系数分别为0.87、0.84和0.69(P<0.05);T 1、T 3~T 5时CSI低于BIS(P<0.05),T 8~T 9时CSI高于BIS(P<0.05);苏醒期CSI与MOAA/S的Spearman相关系数为0.77(P<0.05),BIS与MOAA/S的Spearman相关系数为0.75(P<0.05)。A、B组山形图示两组CSI与BIS在维持期一致性好,苏醒期一致性弱。结论CSI与BIS在学龄前和学龄儿童静脉麻醉状态下具有良好的相关性;CIS在苏醒期能更好反映意识水平的变化,可用于评估3岁以上儿童静脉麻醉深度。Objective To compare the correlation and consistency between CSI and BIS in monitoring the depth of intravenous anesthesia in children,and evaluate the feasibility of CSI for pediatric monitoring.Methods Sixty pediatric ASAⅠtoⅡ,who were scheduled for arrhythmia radiofrequency ablation were divided into two groups by age with preschool group(3-6years,group A,n=25)and school group(7-15years,group B,n=35).Propofol 2.5mg/kg,cis-atracurium 0.1mg/kg and fentanyl 1μg/kg were administered for induction.For anesthesia maintenance,continuous intravenous infusion of propofol was used to maintain a BIS target value of 65 by a closed-loop mode machine.Remifentanil was continuously infused at a rate of 0.25 to 0.33μg/(kg·min)to maintain a stable hemodynamics.Parameters including CSI and BIS were recorded when patient entered the operating room(T 1),tracheal induction was completed(T 2),operation started(T 3),and at 30 minutes(T 4),60 minutes(T 5),90 minutes(T 6),at the time when intravenous infusion stopped(T 7),the time of extubation(T 8),and the time of leaving the operating room(T 9).The modified awake sedation scores(MOAA/S)were recorded from T 7 to T 9.Results In group A,the Spearman correlation coefficients of CSI and BIS during the T 1-T 2 induction period,T 3-T 6 maintenance period,and T 7-T 9 recovery period were 0.88,0.79,and 0.78,respectively(P<0.05).CSI was lower than BIS from T 1 to T 6(P<0.05),higher than BIS from T 8 to T 9(P<0.05).During the recovery period from T 7 to T 9,the Spearman correlation coefficient between CSI and MOAA/S was 0.87,between BIS and MOAA/S was 0.82(P<0.05).In group B,the Spearman correlation coefficients of CSI and BIS during the T 1-T 2,T 3-T 6,and T 7-T 9 were 0.87,0.84,and 0.69,respectively(P<0.05).CSI was lower than BIS at T 1,T 3-T 5(P<0.05),and CSI was higher than BIS at T 8-T 9(P<0.05).During the recovery period from T 7 to T 9,the Spearman correlation coefficient,between CSI and MOAA/S was 0.77(P<0.05),between BIS and MOAA/S was 0.75(P<0.05).The mountain plot shows the con

关 键 词：麻醉意识深度指数 脑电双频指数 导管消融 儿童 

分 类 号：R72[医药卫生—儿科]